Prognosis in differentiated thyroid carcinoma

Prognosis in differentiated thyroid carcinoma

• The prognosis in di ff erentiated thyroid cancers is generally excellent. In terms of survival, older patients, those with large tumours or those with extrathyroid extension or distant metas - tases have worse outcomes. A system of risk stratification can be used to predict the risk on an individual basis. In a young patient with a low-risk tumour, the risk of death following appropriate treatment is almost zero. In an older patient with a high-risk tumour (extrathyroid extension or distant metasta ses), the risk is as high as 55% at 5 years. Older patients with low-risk tumours and younger patients with high-risk tumours are an intermediate-risk group. Nodal metastases deserve special mention. In younger patients they predict for r rence but not for death. This is because recurrent neck disease in young patients can almost always be successfully salvaged. In contrast, for older patients neck metastases (particularly in the lateral neck) are a marker of distant metastases in some, recurrence and death. The American Joint Committee on Cancer system stages all patients <55 years as stage I unless they have distant metas - tases, when they are stage II. Older T1N0M0 pa tients are stage I and T2N0M0 patients are stage II. The pr esence of nodal disease upstages older patients to stage II, as does T3 disease. All older patients with locally invasive primary disease (T4) or distant metastases are stage IV .

Figure 55.24 Histology of follicular thyroid carcinoma showing vas cular (red arrow) and capsular (black arrow) invasion (courtesy of Dr SWB Ewen, Aberdeen, UK). Figure 55.25 Follicular carcinoma of the thyroid with skull secondaries.

Prognosis in differentiated thyroid carcinoma

• The prognosis in di ff erentiated thyroid cancers is generally excellent. In terms of survival, older patients, those with large tumours or those with extrathyroid extension or distant metas - tases have worse outcomes. A system of risk stratification can be used to predict the risk on an individual basis. In a young patient with a low-risk tumour, the risk of death following appropriate treatment is almost zero. In an older patient with a high-risk tumour (extrathyroid extension or distant metasta ses), the risk is as high as 55% at 5 years. Older patients with low-risk tumours and younger patients with high-risk tumours are an intermediate-risk group. Nodal metastases deserve special mention. In younger patients they predict for r rence but not for death. This is because recurrent neck disease in young patients can almost always be successfully salvaged. In contrast, for older patients neck metastases (particularly in the lateral neck) are a marker of distant metastases in some, recurrence and death. The American Joint Committee on Cancer system stages all patients <55 years as stage I unless they have distant metas - tases, when they are stage II. Older T1N0M0 pa tients are stage I and T2N0M0 patients are stage II. The pr esence of nodal disease upstages older patients to stage II, as does T3 disease. All older patients with locally invasive primary disease (T4) or distant metastases are stage IV .

Figure 55.24 Histology of follicular thyroid carcinoma showing vas cular (red arrow) and capsular (black arrow) invasion (courtesy of Dr SWB Ewen, Aberdeen, UK). Figure 55.25 Follicular carcinoma of the thyroid with skull secondaries.